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Sleep-Disordered Breathing and Cognition in Older Women

Authors

  • Adam P. Spira PhD,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
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  • Terri Blackwell MA,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
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  • Katie L. Stone PhD,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
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  • Susan Redline MD,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
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  • Jane A. Cauley DrPH,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
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  • Sonia Ancoli-Israel PhD,

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
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  • Kristine Yaffe MD

    1. From the *Department of Medicine, Division of Geriatrics, and Departments of ††Psychiatry, ‡‡Neurology, and §§Epidemiology, University of California at San Francisco, San Francisco, CaliforniaSan Francisco Veterans Affairs Medical Center, San Francisco, California;California Pacific Medical Center Research Institute, San Francisco, California§Department of Pediatrics, Case Western Reserve University, Cleveland, OhioDepartment of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania#Department of Psychiatry, University of California, San Diego, California**Veterans Affairs San Diego Healthcare System, SanDiego, California.
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  • This study was presented as a poster at the 20th meeting of the American Association for Geriatric Psychiatry, March 2007, New Orleans, Louisiana.

Address correspondence to Adam P. Spira, PhD, 4150 Clement Street 181-G, San Francisco, CA 94121. E-mail: adam.spira@ucsf.edu

Abstract

OBJECTIVES: To investigate the association between objectively measured sleep-disordered breathing (SDB) and cognitive impairment in community-dwelling older women and to determine whether the apolipoprotein E (APOE) ɛ4 allele modifies this association.

DESIGN: Cross-sectional.

SETTING: Participants' homes and two sites of the Study of Osteoporotic Fractures (SOF).

PARTICIPANTS: Four hundred forty-eight women with a mean age±standard deviation (SD) of 82.8±3.4.

MEASUREMENTS: Participants completed the Mini-Mental State Examination (MMSE), Trail Making Test Part B (Trails B), and polysomnography (PSG). SDB indices were the apnea–hypopnea index (AHI), the central apnea index (CAI), and oxygen saturation (SaO2) nadir less than 80%. APOE ɛ4 was determined for a subset of 242 women. Cognitive impairment was defined as 1.5 SDs or more from the sample mean on either cognitive test (MMSE or Trails B).

RESULTS: All SDB indices were associated with cognitive impairment according to the MMSE (AHI (per SD, odds ratio (OR)=1.4, 95% confidence interval (CI)=1.03–1.9), AHI of ≥30 (OR=3.4, 95% CI=1.4–8.1), SaO2 nadir <80% (OR=2.7, 95% CI=1.1–6.6), and CAI (per SD, OR=1.4, 95% CI=1.1–1.7)). Weaker, nonsignificant associations emerged between SDB and Trails B. In women who completed genotyping, each SD increase in AHI was associated with 70% greater odds of cognitive impairment according to the MMSE (OR=1.7, 95% CI=1.2–2.6). Women with the ɛ4 allele had a nearly five times greater odds of impairment (per SD, OR=4.6, 95% CI-1.0–20.7); the association was smaller and nonsignificant in women without the ɛ4 allele (per SD, OR=1.5, 95% CI-0.9–2.4; P for interaction=.08).

CONCLUSION: SDB is an important risk factor for cognitive impairment in older women, especially those with the APOE ɛ4 allele. Mechanisms linking these disorders need to be identified.

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